Understanding Café Au Lait Birthmarks And Treatment Options

Café au lait birthmarks are among the most common forms of pigmented birthmarks found in newborns and young children. These distinctive marks, characterised by their light to dark brown colour and flat appearance¹, can raise concerns for parents and caregivers. Although most café au lait birthmarks are innocuous, it is important to understand them and the possible treatments for your peace of mind.

Keep reading as we discuss what they are, their causes, and the treatment options available today!

Café au lait birthmarks defined

Café au lait birthmarks, also known as ‘CAL spots’ or ‘café-au-lait spots’, are pigmented birthmarks that appear as flat, light to dark brown patches on the skin. They are typically round or oval and often appear at birth or shortly after that. The moniker ‘café-au-lait’ derives its name from the French language, translating to ‘coffee with milk’. This nomenclature aptly captures the birthmark’s colour, resembling the creamy blend of coffee and milk. These birthmarks exhibit a spectrum of sizes, ranging from mere millimetres to more than 20 centimetres in diameter¹.

CAL spots are usually harmless and painless, and while some people may have only one café au lait birthmark, others can have multiple scattered across their bodies.

Causes of café au lait birthmarks

These birthmarks arise as a result of a surplus of melanocytes, the cells responsible for melanin production. Melanin, the protective pigment dictating the colour of our eyes, hair, and skin, is produced by melanocytes, specialised cells in the skin. The precise trigger for the increase in melanocyte cells is not known¹, but when melanocytes produce an excess of melanin in a specific area of the skin, it leads to the formation of a café au lait birthmark.

That said, these CAL spots are not hereditary or related to genetics or family history. Instead, they appear to happen sporadically and without a distinct inheritance pattern.

When you should see a doctor

In most cases, café au lait birthmarks do not require medical attention. However, there are certain situations where it is advisable to consult a healthcare professional;

1. Sudden appearance: If a café au lait birthmark suddenly appears in adulthood, it may warrant a medical evaluation to rule out underlying health conditions or whether it is another type of pigmented lesion.

2. Rapid growth: If an existing birthmark experiences rapid growth or changes in texture, shape, or colour, it should be examined by a doctor.

3. Multiple birthmarks: Should you have between one to three spots, your doctor might conclude that further testing is not necessary. Conversely, if you have six or more spots, each measuring a minimum of one centimetre, and you also have freckles in the vicinity of the underarms and groin, your doctor may suspect neurofibromatosis².

4. Associated symptoms: If the birthmark is accompanied by other concerning symptoms like bleeding, itching, or pain, medical advice should be sought.

Treatment options available today

Café au lait birthmarks are generally benign and do not require treatment for health or cosmetic reasons. But if you would like to pursue treatment options for aesthetic or personal reasons, here are some common options to consider;

Topical creams

Should you visit a dermatology clinic, some topical creams containing ingredients like retinoids and hydroquinone may be prescribed by a dermatologist to lighten the pigmentation of café au lait birthmarks³ over time.

Laser treatment

Laser treatment is a popular option for reducing the appearance of café au lait birthmarks. At Angeline Yong Dermatology, we utilise both the PicoWay or PicoSure laser in Singapore to treat epidermal pigmentation like café au lait macules with satisfactory results.

Conclusion

Despite the fact that café au lait birthmarks are benign, it is best to seek medical advice if you observe any significant changes in their appearance or if you have numerous birthmarks that raise questions about underlying health disorders.

It is crucial to speak with a dermatologist or healthcare professional to decide the best course of action for your circumstances. If you are looking to consult an MOH-accredited dermatologist for a birthmark or mole check, or perhaps skin cancer screening in Singapore, do not hesitate to book an appointment with Dr Angeline Yong at Angeline Yong Dermatology today.

References

Café-au-lait spots. Cleveland Clinic. (n.d.-b). https://my.clevelandclinic.org/health/diseases/22627-cafe-au-lait-spots

Higuera, V. (2018, April 11). Café au lait spots: In babies, differential diagnosis, and more. Healthline. https://www.healthline.com/health/cafe-au-lait-spots

Plensdorf, S., & Martinez, J. (2009, January 15). Common pigmentation disorders. American Family Physician. https://www.aafp.org/pubs/afp/issues/2009/0115/p109.html

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Understanding Café Au Lait Birthmarks And Treatment Options